Working with Limited Resources in India: Take-Home Messages from the 2015 Bethune Round Table

Introduction

The Bethune Round Table (BRT) is an annual interdisciplinary scientific meeting held at academic institutions in Canada for sharing of challenges and solutions for improving the surgical care provided to under-served and marginalized populations in low- and middle-income countries (1). The BRT aims to bring various health professionals together to share surgical research and experiences from low-resource settings. This includes surgeons, anesthesiologists, obstetricians, pathologists, nurses, public health workers, and government workers. The program was originally started at the University of Toronto in 2001. The 2015 BRT was held at the University of Calgary from June 4-7, 2015. The theme of the conference was “socially accountable surgical care.”

The Northern Ontario School of Medicine (NOSM)

NOSM is focused on community-engaged and socially accountable education. It is a unique medical college providing relevant clinical experience with the guidance of working health professionals in community hospitals, clinics and family practices.

The school has many partnerships and collaborations which aid in their success. The entire learning process is based on clinical study, and although special training programs are available, there is no quota for the aboriginal population.

Global Challenges

Globally, 60% of the surgical procedures are carried out for 15% of the world population in developed countries. On the other hand, 34% of the poor who live in developing countries get only 3% of the world’s surgeries. While the World Health Organization (WHO) recommends that there should be at least 20 surgeons per 100,000 population, countries like Rwanda have only 0.4 surgeons per 100,000 population. The WHO has defined a list of 44 essential surgical procedures, of which 28 are possible in a primary care setting. These can avert 87,000 DALYs (Disability Adjusted Life Years). The cost of intervention to prevent DALYs is most efficient for surgical conditions. For instance, ORS spends $1,000 per DALY averted, and HIV is about $900 per DALY averted, while surgeries are from only $15 onwards per DALY averted. Lifebox (lifebox.org) is an organization teaching the WHO checklist (19 of them for safe surgery) and offering low-cost pulse oximeters.

The Rwanda Experience with Training Nurses

Rwanda has 20 nurses per 100,000 population, unlike Canada which has 1,043 nurses per 100,000. A special 4-week training program for operating room nurses led to a 94 to 100% retention rate, of the trained nurses in the ORs. Training in sterile field techniques, pain management, family-centered care and team training led to a vast improvement in the quality of care.